Healthcare Follies: Part Three—Timeworn Falsehoods
As the debate about “Medicare for All” heats up, we will continue to help our readers sift through the noise and find the facts. Our launch point today is a recent editorial appearing in the New York Times by Vin Gupta, assistant professor of global health at the Institute for Health Metrics and Evaluation. His title was “The Unforced Error of Medicare for All: Democrats would be wise to seek reform, not revolution.” In the article, Mr. Gupta says the following: “Recent polling from the Kaiser Family Foundation shows that although voters like the concept of Medicare for All, net favorability falls by almost 50 points when they are presented with hard truths such as the higher taxes, less provider choice, and increased wait times that will inevitably result.” “Hard truths?” We don’t think so.
First, it hardly seems “revolutionary” to seek a system like we see in Germany, France, and Japan, to name a few, that provide better outcomes at lower prices than does our healthcare system. Secondly, it should as no surprise that if you present a false choice in a polling question, you will get the answer you want. After all, who wants higher taxes and waiting lines? That should come as no surprise. But, rather than split hairs about what we call it or poor polling, let’s just focus on what Mr. Gupta refers to as “hard truths.” A quick review of our Healthcare Research will easily demonstrate that these are hardly “hard truths,” but we will spare you the time with a few summary observations here.
First, let's take the question of higher taxes. In the US, our healthcare system costs us approximately 18% of GDP versus about 10% in the countries mentioned above. To succeed, we must bring down prices by eliminating for-profit insurance administration, and negotiating the prices of drugs and healthcare professionals down to world levels. When we do that, whether we continue to pay for healthcare through our employers or directly to a government program, costs will be less, not more. If “Medicare for All” takes a form that excludes employer-based coverage, we may pay in taxes what we now pay in premiums, deductibles, and employer contributions. So, strictly speaking, taxes would rise but would be offset by savings elsewhere. If the question were put this way, it would surely have received a different answer.
Second “hard truth”: less provider choice. Again, if it is provider choice you want, you need to look no further than the German approach. In Germany, there are approximately 250 nonprofit providers who compete for customers. Consumers are free to choose any of them, to switch between them at will, and to keep them independent of their employer or employment.
Third “hard truth”: increased wait times. This is an old trope that had a basis in fact years ago when the UK was struggling to get its system right. It still may be true that certain elective surgeries in certain countries have wait times. But again, in the countries mentioned above, and the ones that we define as setting an example of what is possible, there is no evidence of wait times. In Japan, in fact, the average person sees a doctor 14 times per year. In France the number is 8 times. In the US, it is 5 times. Access is in fact greater, not less. And, by the way—here we are clearly being anecdotal—based on our personal experience, GP referrals to sought-after specialists in the US can often involve several-month wait times.